Provider Demographics
NPI:1295903870
Name:RICHARD H. BLUM MD
Entity type:Organization
Organization Name:RICHARD H. BLUM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-826-0526
Mailing Address - Street 1:545 N RIVER ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2600
Mailing Address - Country:US
Mailing Address - Phone:570-826-0526
Mailing Address - Fax:570-824-0688
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 230
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-826-0526
Practice Address - Fax:570-824-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17389E261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
051059Medicare PIN